Individual provider Active NPI

Purita Episcope Ambat, DMD

  • General Practice Physician
  • Brooklyn, NY
National Provider Identifier
1093728339
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
036611 Issued in NY
Practice address
749 Grand Street
Brooklyn, NY 11211
Phone
(718) 388-7007
Fax
(718) 388-7007
NPI assigned
Aug 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 036611 NY Primary

Addresses

Primary practice location

749 Grand Street
Brooklyn, NY 11211

Mailing address

749 Grand Street
Brooklyn, NY 11211
Phone (718) 388-7007

Other identifiers 1

IdentifierTypeStateIssuer
00715417MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
036611NYMDGeneral Practice Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093728339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "749 GRAND STREET",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11211",
            "telephone_number": "718-388-7007",
            "fax_number": "718-388-7007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "749 GRAND STREET",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11211",
            "telephone_number": "718-388-7007",
            "fax_number": "718-388-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBAT",
        "first_name": "PURITA",
        "middle_name": "EPISCOPE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "036611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00715417",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.